Global research trends in postoperative ileus from 2011 to 2023:A scientometric study

BACKGROUND Postoperative ileus(POI)is a common complication after abdominal surgery with high morbidity,which hinders patient recovery,prolongs hospitalization,and increases healthcare costs.Therefore,POI has become a global public health challenge.POI triggering is multifactorial.Autonomic and hormonal mechanisms are generally involved in POI pathogenesis.Recent studies have shown that beta adrenergic signaling of enteric glia is a POI trigger.Currently,the status quo,trends,and frontiers of global research on POI remain unclear.AIM To explore the current status,trends,and frontiers of POI research from 2011 to the present based on bibliometric analysis.METHODS Publications published on POI research from 2011 to 2023 were retrieved on June 1,2023,from the Web of Science Core Collection.CiteSpace 6.2.R2 and VOSviewer were used to conduct bibliometric visualization.RESULTS In total,778 POI records published from 2011 to 2023 were retrieved.Over the past few decades,the annual cumulative number of related articles has linearly increased,with China and the United States of America contributing prominently.All publications were from 59 countries and territories.China and the University of Bonn were the top contributing country and institution,respectively.Neurogastroenterology&Motility was the most prolific journal.The Journal of Gastrointestinal Surgery had the highest number of citations.Wehner Sven was the most productive author.Burst keywords(e.g.,colon,prolonged ileus,acupuncture,paralytic ileus,pathophysiology,rectal cancer,gastrointestinal function,risk)and a series of reference citation bursts provided evidence for the research frontiers in recent years.CONCLUSION This study demonstrates trends in the published literature on POI and provides new insights for researchers.It emphasizes the importance of multidisciplinary cooperation in the development of this field.

Acupuncture therapies in combination with conservative treatments for postoperative ileus:a systematic review and network meta-analysis

Background:Although acupuncture therapies have been widely used in combination with conservative treatments(CT)for postoperative ileus(POI),evidence of their safety and efficacy remains scarce.To evaluate and rank the efficacy of different acupuncture therapies combined with CT for POI.Methods:A comprehensive search was carried out in several databases(Embase,PubMed,Cochrane Library,Chinese National Knowledge Infrastructure,Wanfang Data,VIP Chinese Science and Technology Periodical Database and China Biology Medicine disc)for relevant randomized controlled trials(RCTs)investigating different acupuncture therapies for POI from inception to February 17,2023.The Cochrane risk of bias tool was used to determine the risks of bias of the included RCTs.The primary outcomes included the time to first defecation,time to first flatus,and time to first bowel movement;and the secondary outcome was the response rate.Pairwise meta-analysis was performed by Review Manager 5.3 software,and network meta-analysis was carried out by Stata v.15.0 software.The cumulative ranking curve was obtained with Stata v.15.0 and was utilized to rank the included treatments.Results:29 studies with 2,600 participants were included in this systematic review.This meta-analysis demonstrated that all acupuncture therapies combined with CT were superior to conservative treatments alone in time to first defecation,time to first flatus,time to first bowel movement,and response rate.Among 10 evaluated methods,auricular needle with CT was the most effective treatment to reduce the time to first defecation.Furthermore,moxibustion with CT was the most effective in reducing the time to first flatus,and warm needling with CT most markedly reduced the time to first bowel movement among 9 interventions.Moreover,manual acupuncture with CT showed the largest improvement in response rate.Conclusion:This meta-analysis revealed that all acupuncture therapies are effective and safe for POI,with warm needling+CT being the most effective way to relieve symptoms.These results indicated that acupuncture therapies combined with CT should be considered for POI patients.However,most of the included trials were ranked as moderate quality,and further large-scale,high-quality RCTs are required to confirm the optimal interventions for POI patients.

Postoperative ileus: Impact of pharmacological treatment,laparoscopic surgery and enhanced recovery pathways

Almost all patients develop postoperative ileus (POI) after abdominal surgery.POI represents the single largest factor influencing length of stay (LOS) after bowel resection,and has great implications for patients and resource utilization in health care.New methods to treat and decrease the length of POI are therefore of great importance.During the past decade,a substantial amount of research has been performed evaluating POI,and great progress has been made in our understanding and treatment of POI.Laparoscopic procedures,enhanced recovery pathways and pharmacologic treatment have been introduced.Each factor has substantially contributed to decreasing the length of POI and thus LOS after bowel resection.This editorial outlines resource utilization of POI,normal physiology of gut motility and pathogenesis of POI.Pharmacological treatment,fast track protocols and laparoscopic surgery can each have significant impact on pathways causing POI.The optimal integration of these treatment options continues to be assessed in prospective studies.

Controlling postoperative ileus by vagal activation

Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. Activation of inhibitory neural pathways by nociceptive stimuli leads to an inhibition of propulsive activity, which resolves shortly after closure of the abdomen. The subsequent formation of an inflammatory infiltrate in the muscular layers of the intestine results in a more prolonged phase of ileus. Over the last decade, clinical strategies focusing on reduction of surgical stress and promoting postoperative recovery have improved the course of postoperative ileus. Additionally, recent experimental evidence implicated antiinflammatory interventions, such as vagal stimulation, as potential targets to treat postoperative ileus and reduce the period of intestinal hypomotility. Activation of nicotinic receptors on inflammatory cells by vagal input attenuates inflammation and promotes gastrointestinal motility in experimental models of ileus. A novel physiologicalintervention to activate this neuroimmune pathway is enteral administration of lipid-rich nutrition. Perioperative administration of lipid-rich nutrition reduced manipulation-induced local inflammation of the intestine and accelerated recovery of bowel movement. The application of safe and easy to use antiinflammatory interventions, together with the current multimodal approach, could reduce postoperative ileus to an absolute minimum and shorten hospital stay.

Predicting prolonged postoperative ileus in gastric cancer patients based on bowel sounds using intelligent auscultation and machine learning

BACKGROUND Prolonged postoperative ileus(PPOI)delays the postoperative recovery of gastrointestinal function in patients with gastric cancer(GC),leading to longer hospitalization and higher healthcare expenditure.However,effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of AIM To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice.METHODS This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021.Among them,PPOI was reported in 33 cases.The patients were randomly divided into the training and validation cohorts.Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model.RESULTS The analysis identified six potential variables associated with PPOI among the included participants.The incidence rate of PPOI was 27.5%.Age≥70 years,cTNM stage(Ⅰ and Ⅳ),preoperative hypoproteinemia,recovery time of bowel sounds(RTBS),number of bowel sounds(NBS),and frequency of bowel sounds(FBS)were independent risk factors for PPOI.The Bayesian model demonstrated good performance with internal validation:Training cohort[area under the curve(AUC)=0.880,accuracy=0.823,Brier score=0.139]and validation cohort(AUC=0.747,accuracy=0.690,Brier score=0.215).The model showed a good fit and calibration in the decision curve analysis,indicating a significant net benefit.CONCLUSION PPOI is a common complication following gastrectomy in patients with GC and is associated with age,cTNM stage,preoperative hypoproteinemia,and specific bowel sound-related indices(RTBS,NBS,and FBS).To facilitate early intervention and improve patient outcomes,clinicians should consider these factors,optimize preoperative nutritional status,and implement routine postoperative bowel sound monitoring.This study introduces an accessible machine learning model for predicting PPOI in patients with GC.